When Rosemary was brought to her local emergency department for treatment, she was homeless, diagnosed with pneumonia, and struggling with addiction. When it came time for her to be released, the hospital identified a housing program for Rosemary (not her real name) that seemed like a good match for her needs. Her doctors were uncertain, however, about whether they could share all, some, or none of her medical records with the housing program. They were also unclear about how to handle disclosure of her addiction disorders to the primary care clinic where she would be receiving her medical care.
These are the kinds of confusing legal and administrative obstacles that frustrate attempts to coordinate behavioral and physical health care. Hospitals, physicians, clinics, health plans, drug treatment centers, and mental health care facilities rarely have the comprehensive data necessary to understand patients’ complete health histories and the care they receive in other settings.
To advance the safe and legal sharing of patient data, CHCF is embarking on a new effort with the California Office of Health Information Integrity (CalOHII). With CHCF’s support, CalOHII will develop and disseminate official state guidance on the use, disclosure, and protection of sensitive health information — especially mental health and substance use disorder information. This non-mandatory guidance will create business terms of engagement for clinics, hospitals, county systems, and repositories of patient records known as health information exchanges. CalOHII’s efforts will fill a critical need for guidance for behavioral health integration initiatives at the state and local levels.
Many factors impede the sharing of patient data for the purposes of care coordination, but one that frequently rises to the top is the lack of clarity about what’s legally permissible, particularly when it comes to behavioral health data. Misconceptions about the Health Insurance Portability and Accountability Act (HIPAA), the federal regulations that govern disclosure of substance use treatment data, and other federal and state health data privacy laws, frequently stand in the way. Health systems may get conflicting guidance from their legal counsel. Providers are sometimes so concerned about liability that they shrink from sharing any data at all. To help explain current regulations and laws, CHCF published Fine Print: Rules for Exchanging Behavioral Health Information in California in 2015.
CHCF’s goal is that CalOHII guidance will encourage the safe, effective, and legal exchange of data to achieve better health outcomes and coordination of care. The formal guidance document, expected in mid-2017, will outline the state’s interpretation of current laws governing how data can be shared, with whom, and for what purposes. Importantly, it will focus more on what providers and health care systems can do than on what they can’t do. CalOHII will be soliciting input and guidance from stakeholders over the coming months. If you would like more information, contact Elaine Scordakis, CalOHII assistant director and project lead.
CHCF believes strongly in accelerating effective, integrated care for all Californians. Advancing safe and legal patient data-sharing while protecting individuals’ privacy rights will be a huge step toward achieving that goal. I look forward to sharing the results of this important project as they become available.
Catherine Teare is associate director of CHCF’s High-Value Care team, which supports policies and care models that align with patient preferences, are proven effective, and are affordable. She leads the foundation’s work on behavioral health care, including behavioral health integration in primary care and behavioral health interventions for high-cost populations. She also manages projects related to the county role in health care delivery and oral health care.
Catherine has worked at CHCF since 2011 and previously led the organization’s efforts on enrollment in public programs, with a particular focus on consumer experience. Before joining the foundation, she worked as a consultant for safety-net health care providers, foundations, and local government, providing research and policy analysis in the areas of health care financing and delivery, public and private health insurance programs for children, adolescent health, reproductive health, HIV, and youth development. She also worked as director of policy for Children Now and as a health policy analyst for the National Center for Youth Law. She received a bachelor’s degree in English from Yale College and a master’s degree in public policy from the University of California, Berkeley.